Infusion Center Blog

Infusion centers today are challenged by many issues today from ASP + 6 pricing, increased costs, and more insurance rejections - it just seems like margins are getting "thinner". Here are 3 ideas to enhance your bottom line. Remember, to increase your profits you can either increase revenue or decrease expenses - typically there are opportunities for improvement on both the revenue and expense side.

1.Know your customer – in health care we are often challenged by the question “who is my customer”?Unfortunately it is often not clear.A nurse will almost always see the patient as the customer; the administrator identifies the insurance company as the gatekeeper of the money and therefore the customer.Traditionally the employer has carried the greatest burden of the cost so they can be a customer as well, but let’s dig deeper.If you’re running an infusion center and trying to garner additional patients often times the customer is a bit more tangential.Think of the case manager at the health plan that may recommend your center, what about the referral coordinator at the referring doctor’s office, or a sub-specialty physician who identifies your venue as a more appropriate place of service?As you can see, there are many customers, and it is important to make sure that they know they are important, that they receive the information they need to do their job (such as communication on the status of the patient, any change in meds etc).The insurance companies measure lots of things, but if you conduct survey’s or studies they might be interested in learning how you operate and in the long run refer more patients to you.

2.Develop a process to manage and maintain the eligibility of patients, and verify that insurance before each visit.Many of the drugs infused at your facility are extremely costly many biologic pharmaceuticals or orphan drugs can cost several thousand dollars.We try to encourage front desk staff to remember a) Verification – that they have insurance and b) Eligibility – are they eligible to receive this product.Insurance companies have developed protocols to save the plan, the patient and the employer money – unfortunately, that does not always fit with your treatment plan.So, even if a patient is eligible, develop a strategy to ensure that each patient is eligible for the treatment before you begin the infusion.It may not feel like you’ve developed a model of efficiency, but in the long run your revenue cycle (the amount of time it takes to treat, bill and collect) will improve.

3.Create a Charge Master a.k.a. fee schedule that will help you identify if you will have a profit margin on the drugs you infuse.With the volatility of the reimbursement of drugs and the ever changing prices of pharmaceuticals you owe it to the organization to develop a charge master.First, identify 80% of the payers, likely that will be four or five insurance carriers.Next, compile a list of drugs and procedures that you perform in your facility.You can do this on paper, but due to the dynamics of this business we always recommend you have an Excel spreadsheet charge master (need help to configure this?Just send us an e-mail we’ll send you a free spreadsheet template with the formulas already built).Finally, you’ve got to find out what the carriers pay for their products and what your acquisition costs are.Of course you have to manage this whenever there are changes in reimbursement or acquisition costs, you need to update the spreadsheet.You will be surprised, once the spreadsheet is designed, the maintenance will really enhance the revenue at your infusion center.